The aim of this review is to explore the intersections of factors associated with both homelessness and Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and other diverse sexual orientations and gender identities (LGBTIQ+) in order to examine their role in experiences of LGBTIQ+ homelessness. Multiple studies have shown LGBTIQ+ people are more likely to be homeless than non-LGBTIQ+ people [1
]. LGBTIQ+ people comprise an estimated 20–40% of homeless populations, whilst only comprising 5–10% of the wider population [5
]. Despite this, much of the existing literature focuses on specific elements of LGBTIQ+ homelessness, and often does not consider the intersections of these elements. In researching factors of LGBTIQ+ homelessness in siloes, we are at risk of falling into scattered, disjointed understandings of the issue, resulting in piecemeal solutions [6
]. Intersectional research conversations need to occur. The goal of this review is to identify the key themes in the existing research, and analyse how these themes interact to reinforce the discrimination and stigma faced by LGBTIQ+ people who experience homelessness.
] defines homelessness as exclusion from physical, social, and legal domains, and exclusion from any one or two of these domains is defined as housing exclusion. Amore et al. [9
] argue homelessness should be replaced by the concept of severe housing deprivation, which includes two main criteria; (1) that a person is living in severely inadequate housing due to (2) a lack of access to housing that meets a minimum adequacy standard (rather than living in such circumstances by choice) [9
]. Severe housing deprivation consists of experiencing any two of three categories; inadequate privacy and control; inadequate security of tenure; and inadequate/uninhabitable structure [9
]. Homelessness thus includes rough sleeping, couch surfing, living in shelters and women’s refuges, and living in cars, caravans, and tents [9
]. The Amore et al. definition is used in this paper, as it is a more comprehensive definition of homelessness.
This literature review aims to clarify the relationships between LGBTIQ+ identity and the key themes in the literature. The key themes are; poverty, ethnicity and racism, substance use, mental health, sexual abuse, foster care, LGBTIQ+ discrimination and stigma, family, survival sex and sex work, physical ill-health and Human Immunodeficiency Virus (HIV), and shelter inaccessibility. This review focuses on the interconnections between these experiences, using Kimberlé Crenshaw’s [10
] theory of intersectionality, which argues people experience different and multiple oppressions in response to their different identities—for example, a person living in poverty, a person’s ethnicity, their gender—which compounds negative health and social outcomes. The concept of intersectionality highlights the interactions between people’s multiples identities and systems of oppression and the resulting complex outcomes [11
]. This paper examines the interactions between multiple identities, such as LGBTIQ+, ethnicity, and systemic failures such as discrimination and stigma, in order to explore experiences of LGBTIQ+ homelessness. It is necessary to understand these identities and experiences together, as the way in which people identify is not based solely on one category, but rather, is a collection of multiple identities and experiences [12
]. Intersectionality encourages us to consider how upstream social determinants (such as racism, sexism, classism, transphobia, and queerphobia) form interlocking systems of oppression which shape the experience of people with multi-dimensional identities [13
This paper builds on existing LGBTIQ+ homeless literature, examining the intersections of key themes faced by both people who identify as LGBTIQ+ and people who are homeless. We propose a new way of categorising and visualising the key themes, as presented in Figure 1
. This diagram places the themes in relation to each other, thus enabling them to be understood synergistically.
The first grouping was of proximate causes of homelessness and included the poverty, ethnicity and racism, substance use, and mental health themes. The racism that ethnic minorities face can directly contribute to poverty and poor mental health, which can, in turn, lead to a person becoming homeless [12
]. Similarly, poverty can lead to poor mental health and substance use, just as poor mental health and substance use can lead to poverty [16
]. Thus, the relationship between all these factors is bi-directional; each can lead to the other. These amplifications of multiple negative factors that cause homelessness show a clear failure to care for those who are most vulnerable.
The second grouping was of systematic failures and included sexual abuse, foster care, discrimination and stigma, and family. LGBTIQ+ identity has a considerable role within this grouping and its relationship to these themes acts as longer-term drivers of homelessness. As shown in the results, unsafe family situations can result in foster care placement. Foster care has a bi-directional relationship with sexual abuse. The literature showed that sexual abuse (particularly within family structures) can result in a young person being placed into foster care [29
]. Youth might then experience sexual abuse within the foster care system [82
]. Foster care has a bi-directional relationship with discrimination and stigma; young people might experience high levels of discrimination and thus be placed into foster care; where they might experience further, or initial, discrimination and stigma due to their LGBTIQ+ identity [53
]. Failures in care systems have the potential to induce substance abuse and poor mental health. Additionally, they can produce economic and social vulnerability which encourages people to engage in survival sex and sex work [59
]. Survival sex may also enable people to provide for themselves in order for them to be able to leave untenable family or foster care situations. Mental health is affected by all of the themes in this grouping; experiencing any of these four systematic failures can result in poor mental health [2
]. Thus, interventions targeted at addressing these factors must also consider the ways in which they impact on people’s mental wellbeing, and ensure the intersectional nature of these issues is considered. It is primarily as a result of failures in these systems that LGBTIQ+ people experience poor mental health. The overlapping nature of these systematic failures shows a need for an inclusive, intersectional system to prevent homelessness.
The third grouping was of experiences during homelessness and included survival sex and sex work, physical ill-health and HIV, and shelter inaccessibility. This grouping has a strong immediate relationship to LGBTIQ+ identity, which indicates both direct and indirect discrimination in the ways in which the right to housing is realised. Survival sex and sex work have a bi-directional relationship with physical ill-health and HIV. Survival sex and sex work puts people at greater risk of contracting HIV and experiencing ill health [57
]. Physical victimisation and ill health can result in people engaging in survival sex and sex work in order to meet their survival needs [84
]. Survival sex and sex work also have a bi-directional relationship with shelter inaccessibility. When shelters are inaccessible to LGBTIQ+ people, they are more likely to engage in survival sex in order to find accommodation and/or money to meet their needs [84
]. On the other side of this relationship, shelters have the potential to become inaccessible to people who are engaging in survival sex or sex work due to strict shelter policy regarding illegal behaviours. Both the proximate causes of homelessness and systematic failures lead to these experiences LGBTIQ+ people have while homeless.
Focusing primarily on negative aspects of LGBTIQ+ homelessness provides an incomplete, one-dimensional understanding of the issue [68
]. This undermines the resourcefulness of these people and the instances of affirmation, connection, growth, and self-sufficiency they experience [68
]. Reframing understandings of LGBTIQ+ homelessness has the ability to prevent us from confining interventions to risk-reduction models, and instead move towards strength-based models [68
]. The relationships between the key themes indicates LGBTIQ+ people are willing to risk their health, and safety, in order to meet some of their needs, such as a place to sleep, food, money, and drugs. This suggests LGBTIQ+ people are often brave and resourceful in their engagement in behaviours that enable them to maintain their identity and to meet their survival needs. For example, this bravery can be seen when LGBTIQ+ people leave family and/or foster care situations in order to look after their physical and mental wellbeing. In viewing the survival strategies of LGBTIQ+ people as bravery and a lack of timidity, we are able to move from a purely deficit-focused view, to one that acknowledges their resiliency. Further research is needed to continue to expand upon this strengths-based understanding of LGBTIQ+ homelessness.
Literature from Hunter [85
], Shelton [86
], Abramovich [76
], and Maccio and Ferguson [75
] indicated a need for service providers to be aware of the particular issues LGBTIQ+ homeless people face, and work towards addressing these concerns. Hunter [85
] identifies four main changes service providers should implement: private showering facilities, low-occupancy limits, housing programs that are prevented from discriminating on the basis of sexual orientation and/or gender expression, and specific LGBTIQ+ non-discrimination and sensitivity training for all staff. Ensign and Bell [88
] found street-based people are more likely to visit emergency departments than shelter-based people. Thus, those in the shelter system have access to greater social and cultural capital than rough sleepers and other homeless people outside of the shelter system. It is possible LGBTIQ+ people are missing out on the support and knowledge provided by shelters, due to their often adverse feelings towards, and experiences of, shelters. With LGBTIQ+ people so over-represented in homeless populations, shelter staff need to undergo cultural competency training in order to provide culturally sensitive support [75
As shown in Section 3.3
, systems failures in early life are a key driver of LGBTIQ+ homelessness, particularly in early life. The interconnected nature of these system failures means we cannot address the failures in one system without addressing the failures in the others. The intersectionality of LGBTIQ+ people’s experiences with homelessness, poverty, and ethnicity makes them particularly vulnerable to these systems failures. This indicates a need to rethink and redesign these early-life systems, with targeted interventions for LGBTIQ+ people kept at the core of any changes. Such changes could include LGBTIQ+-specific protections in government policy, and LGBTIQ+ cultural competency training for those who work in related fields. Failing to address these needs breaches one’s right to housing and results in unequal outcomes, as evidenced by the high rates of LGBTIQ+ homelessness. This represents a failure in both policy and social wellbeing to support our most vulnerable.
The main limitation to this paper is related to the literature search; namely, that the initial search terms were somewhat inefficient at finding relevant research. As discussed in the Methods section, 27 relevant articles were obtained from the literature searches, and a further 26 came from reviewing the reference lists of those articles. Thus, almost half of the relevant articles did not come from the literature searches. Search terms could have thus been broadened and altered to capture a larger proportion of the relevant articles. It is possible that we have missed articles which use alternate terms and keywords such as “sexuality” or “sexual orientation” instead of “LGBT” and “Queer”, as we have used, which have only been rising in usage in recent decades. Another limitation of this study is the narrow geographic range of the literature; most articles come from North America, with a few from Australia and Europe. Further research would benefit from exploring the issue of LGBTIQ+ homelessness in a wider range of locations. This would broaden our understanding of the issue and allow us to see how LGBTIQ+ people’s experiences of homelessness differ across a range of social, political, cultural, and economic contexts.